So, you probably already know that Blue Cross Blue Shield of RI is no longer asking for a 4.4% rate increase. The health insurance company reduced its request to 2.4% at a public hearing earlier this week.

In 2011, the deductible did not apply to the out of pocket max. However, in 2012 the deductible amount applies to the out of pocket maximum.

Essentially, when you look at the out of pocket maximum for the old plans, that’s actually NOT the maximum. The most you would pay out of pocket is that amount PLUS your deductible. But that’s only in the case of the 500/1000 and 2000/4000 plans.

The deductible, infertility treatment copayment, flat dollar copayments, and prescription drug copayment do NOT apply to the maximum out-of-pocket expense; therefore, the level of coverage will not be increased to 100%.

My apologies for getting this wrong, but perhaps it’s an indication that this information needs to be more accessible. If I missed this detail after several hours of research, someone who doesn’t do this for their job might miss it too.

So how does this new information change the ACTUAL cost increase for people on these plans? Here are the new calculations, using myself as an example.

This is much lower than the cost increase calculated in my earlier post, which put the extra cost at $1,346 or an increase of 9.64%. Here, the difference is minor. But the cost increase for the 2000/4000 plan is still significant.

Before, when I thought the deductible counted towards the out of pocket limit, I calculated the cost difference as $9,516 more than the old plan at a cost increase of 74.18%. Now it’s a cost difference of $5,516.60 or a 32.78% increase. Still, much more than a 2.4%.

Reblogged this on Therapy with Kiersten Marek, LICSW and commented:
High deductibles such as those described in this article are a main reason why the middle class is effectively unable to access outpatient mental health care except by paying out of pocket.